Improving therapeutic approaches to insomnia: the need for objective sleep data
Authors: Jitendra Kumar Sinha, Shampa Ghosh, Soumya Ghosh, Rakesh Bhaskar, Sung Soo Han
Journal: The Lancet Healthy Longevity (2023)

We commend Ali Tanweer Siddiquee and colleagues1Siddiquee AT Lee SK Kim S Lee M-H Kim HJ Shin C All-cause and major-cause mortality associated with sleep latency in the Korean Genome and Epidemiology Study (KoGES): a population-based prospective cohort study.Lancet Healthy Longev. 2023; 4: e316-e325Summary Full Text Full Text PDF PubMed Google Scholar for shedding light on the crucial relationship between sleep and health, particularly with regards to mortality risk in adults aged 40–69 years. Although the findings1Siddiquee AT Lee SK Kim S Lee M-H Kim HJ Shin C All-cause and major-cause mortality associated with sleep latency in the Korean Genome and Epidemiology Study (KoGES): a population-based prospective cohort study.Lancet Healthy Longev. 2023; 4: e316-e325Summary Full Text Full Text PDF PubMed Google Scholar presented are of substantial value, we would like to emphasise the importance of incorporating objective measures in the study of insomnia and its effects on health. Siddiquee and colleagues' study showed that prolonged self-reported sleep latency is associated with an increased risk of all-cause and cancer-specific mortality. These results align with those from previous studies showing that the chronicity and severity of objectively measured insomnia, such as insomnia with short sleep duration, contribute to an elevated risk of health issues and mortality.2Vgontzas AN Fernandez-Mendoza J Insomnia with short sleep duration: nosological, diagnostic, and treatment implications.Sleep Med Clin. 2013; 8: 309-322Summary Full Text Full Text PDF PubMed Google Scholar We agree that sleep quality is of paramount importance for maintaining good health and longevity. However, the absence of an association between self-reported sleep latency and cardiovascular mortality could be partly attributed to the limited number of cardiovascular deaths in the cohort. Additionally, data exist to suggest that objective measures of sleep are more accurate in assessing health outcomes, because self-reported sleep variables can be influenced by other physical and mental health factors.3Regestein QR Friebely J Shifren JL et al.Self-reported sleep in postmenopausal women.Menopause. 2004; 11: 198-207Crossref PubMed Scopus (69) Google Scholar Objective measures provide a more accurate representation of sleep patterns, enabling clinicians to make more precise diagnoses, prognoses, and treatment plans for the disorder. Objective measures, including the multiple sleep latency test, have been proposed as essential tools for assessing the severity of insomnia. Studies have consistently shown that insomnia accompanied by objective sleep disturbances, such as short sleep duration, carries a significantly higher risk of cardiometabolic comorbidity and mortality than insomnia per se.2Vgontzas AN Fernandez-Mendoza J Insomnia with short sleep duration: nosological, diagnostic, and treatment implications.Sleep Med Clin. 2013; 8: 309-322Summary Full Text Full Text PDF PubMed Google Scholar, 4Vgontzas AN Fernandez-Mendoza J Liao D Bixler EO Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder.Sleep Med Rev. 2013; 17: 241-254Crossref PubMed Scopus (485) Google Scholar Dysregulation of the hypothalamic–pituitary axis, sympathetic overactivation, and systemic inflammation have been implicated as key pathological changes. Further investigation into these mechanisms is crucial for the development of effective therapeutic approaches to minimise the adverse effects of insomnia on health. In this context, we would like to highlight the promising potential of personalised treatments. Studies have shown that trazodone has superior efficacy in treating insomnia with objective short sleep duration compared with cognitive behavioural therapy. Nevertheless, cognitive behavioural therapy has been found to be particularly beneficial for individuals with paradoxical insomnia,5Roniger DDG Lechuga YA León EE et al.Cognitive behavioral therapy for insomnia helps to reverse cognitive impairment in insomnia patients.Sleep Sci. 2022; 15: 355-360Crossref PubMed Scopus (2) Google Scholar indicating that a tailored approach can yield positive outcomes. The research presented by Siddiquee and colleagues1Siddiquee AT Lee SK Kim S Lee M-H Kim HJ Shin C All-cause and major-cause mortality associated with sleep latency in the Korean Genome and Epidemiology Study (KoGES): a population-based prospective cohort study.Lancet Healthy Longev. 2023; 4: e316-e325Summary Full Text Full Text PDF PubMed Google Scholar underscores the importance of insomnia as a serious medical concern. Future large-scale, multisite, randomised, placebo-controlled trials should explore personalised treatments for different insomnia subtypes, thereby promoting healthy longevity for individuals worldwide. We declare no competing interests. JKS and ShG contributed equally.